Carga global de la enfermedad neumocócia

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1 Carga global de la enfermedad neumocócia Ann R. Thomas, MD MPH Public Health Division Portland, Oregon Caracas, Venezuela, January 2008 Acknowledgements to Adam Cohen, CDC

2 Principales Causas de Muertes por Enfermedades Infecciosas (estimados) Deaths (millions) Fuente: WHO, < 5 years old > 5 years old 0 Pneumonia SIDA Diarrea TB Malaria Sarampión 1.7 S. pneumoniae: ~1.6 millones muertes, incluyen ~800,000 muertes en niños

3 WHO estimates 2.7M childhood deaths from vaccine preventable illnesses. S. pneumo DTP/Polio Pneumo, Hib & Rotavirus account for ~60% of vaccine preventable deaths in children Hib Rotavirus Measles HepB YF MenAC

4 Global Distribution of Childhood Pneumonia Deaths PneumoADIP / WHO

5 WHO Global Disease Burden Project Objective: to generate country-specific Hib and Pneumo burden estimates Database of evidence Systematically collected Publicly available Methods for estimation Transparent methods Communication of uncertainty of estimates Independent expert committee review x 2 Clearance through WHO-EIP Compatibility with other disease burden estimates Country consultation prior to release of country-level estimates

6 Sample template countries have received

7 Timeline of Disease Burden Project Country Consultation Letters: August 2007 Responses due by September-October (6 weeks) Final numbers by October-November 2007 Publication in Spring/Summer 2008 in Lancet Website with numbers Tool for calculating disease burden in other years/evaluating impact of implementing vaccination programme

8 Serotype distribution of IPD isolates among children < 5 years Global Serotype Project (V.1)

9 Serotype distribution of IPD isolates among children < 5 years Global Serotype Project (V.1) Globally, serotype 14 is the most commonly isolated serotype in children < 5 5 most common (14, 6B, 1, 19F, 23F) account for 60% of IPD 11 serotypes account for >80% Of 90 known serotypes, 15 were not found in any of the datasets

10 Pneumococcal Epidemiology: Invasive disease basics

11 Incidence and Case Fatality Ratio by Age Group Invasive Pneumococcal Disease ABCs 1998 Incidence (cases/100,000 pop) Case fatality ratio Incidence Case fatality ratio (%) < Age group, years Robinson et al JAMA 1998

12 Invasive pneumococcal disease in healthy adults and adults with selected comorbidities United States, 2000 Cases per 100,000 persons Healthy Chronic heart Diabetes Chronic lung 92 Heavy drinker 294 Solid cancer 341 HIV/AIDS 432 Blood cancer Kyaw M et al JID 2005

13 Risk Factors for Invasive Pneumococcal Disease J Watt et al, CID 2003 Nuorti et al. NEJM 2000 Kupronis et al. J Am Geriatr Soc 2003

14 Invasive Pneumococcal Disease in Navajo and White Mountain Apache vs. White and Black Persons in the General U.S. Population, Cases per 100,000 pop White (ABCs) Black (ABCs) Navajo J Watt et al, CID 2003

15 Epidemiology of Serotypes Over 90 different pneumococcal serotypes Pneumococcal serotypes causing invasive disease vary Geographically With age With immune status Between some racial/ethnic groups In ability to be carried In invasiveness In disease manifestations they cause In amount of resistance to antibiotics

16 Pneumococcal disease prevention and treatment Case-management antibiotics, oxygen, supportive care Improved nutrition breastfeeding, micronutrients, improved feeding Risk factor reduction indoor air pollution, hand washing, HIV prevention Immunizations

17 Pneumococcal Conjugate Vaccine (PCV7) Prev(e)nar (Wyeth Lederle) 7-valent vaccine Poly- or oligosaccharides of serotypes 4, 6B, 9V, 14, 18C, 19F, 23F Conjugated to CRM197 (diphtheria toxin) Serotype coverage: Close to 90% N America and Australia Should cover over 70% of all disease worldwide

18 Considerations for PCV Introduction Disease burden Serotype coverage: Just a part of the story Absolute burden of vaccine-type disease Cost effectiveness Feasibility/availability

19 Serotype coverage with 7-valent vaccine* in the US and Australia 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 92% 83% Based on serotype coverage alone, Australia would get the highest priority for vaccine introduction, and Navajo would get lowest priority 56% Australia US US - Navajo

20 Preventable incidence rate is the important measure Preventable cases per 100,000 children <5 yo Navajo should be highest, not lowest priority Australia US US - Navajo Preventable incidence = ST coverage x Incidence of disease

21 National Programs Using Conjugate Vaccine National programs USA, Canada, Australia, Luxemburg, Qatar Routine introduction announced for 2006 UK, Holland, Norway, Greece Countries with moderate vaccine use France (broad at risk program) Italy (universal recommendation in 15 / 20 regions) Spain, Portugal (private markets with high coverage). Source: Wyeth

22 Status of national programs and licensure of 7-valent (Apr 2006) Red = Registered and universal infant use or equivalent recommendation (n=13) Blue = Registered but no universal use recommendation (n=61) Map source: June, 2006

23 30 Countries with Interest in PCV-7

24 Vaccine Supply Environment Pneumococcal vaccine pipeline Development Stage Pre-clinical stage Clinical trial Phase I Clinical trial Phase II Clinical trial Phase III Launched Multinational ~20 vaccines in research/ Pre-clinical stage (includes conjugate & protein-based vaccines) 13-valent 9-valent GSK 10- valent 11-valent 7-valent Prevnar (7-valent) Expected launch 2008 (US, Europe) Emerging suppliers >4 multi-valent conjugate vaccine projects Source: BCG Global Supply Strategy 2005 PneumoADIP team analysis

25 Pneumococcal vaccines in use or development Vaccine Serotypes Included Status PCV7 PCV9 PCV10 PCV11 PCV13 4 6B 9V 14 18C 19F 23F PCV PCV9 + 7F PCV PCV11 + 6A 19A Licensed Dropped ~2008? ~2010

26 Pneumo vaccine supply outlook 2-3 Suppliers Multi-nationals >3 Suppliers Multi-nationals and Emerging + Emerging later 2 Multi- National Suppliers 1 Multi- National Supplier 7-valent Single dose syringe 7 valent and 10 valent Single vials?multi-dose valents Single and multi-dose?proteins? 4-14 valents?proteins? Single and multi-dose

27 Surveillance as a cornerstone of vaccine introduction Provides baseline data before vaccine introduction Provides local disease burden data and where possible serotype data Pneumococcal surveillance poses challenges Multiple syndromes (some very common) Limited diagnostics Importance of serotypes

28 Global Framework on Immunization Monitoring and Surveillance (GFIMS) WHO and CDC joint vision By 2010, a strengthened and more integrated epidemiological and laboratory network for vaccine preventable diseases (VPD) surveillance Network that provides high quality information to measure disease burden and impact of vaccines Link with seasonal/pandemic influenza & emerging threats